2025 Breaking BEARriers Membership Form
Breaking BEARriers Youth Leadership Club was founded in 2019 by a few students in Northern California. The club's mission is to promote opportunities that inspire peers to develop creativity, learn persistence, and work respectfully in a team. We encourage participants to use cutting-edge technology and out-of-the-box ideas to solve problems with a strong awareness of the environment and resource challenges that the world is currently facing.

To better serve our communities, we are actively recruiting new members who are passionate about community services. Together we contribute our share of efforts to build a better world! We hope to learn a little more about you and your abilities through this form.

To learn more about current projects and events, visit https://breakingbearriers.org or join our discord: https://discord.gg/tVrHDU6sRg 

Please feel free to contact us at breakingbearriers@gmail.com.

Please write your personal email, not your school email. Thanks :)
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Email *
Student Name *
School Name *
Grade in 2024-2025 School Year *
Parent Name *
Parent Email *
What fields are you interested in? *
Required
If you selected other above, what fields are you interested in?
Anyone who wishes to join this club must carefully and thoroughly read through the Breaking BEARriers Code Of Conduct

 *
Required
What is your discord username + tag? *
If you don't have a discord, you MUST create one to join this club as almost all communication is through there!

Volunteer Liability Waiver Form

Your membership will not be confirmed until Breaking Barriers receives the signed Volunteer Liability Waiver Form.

Please click the following link, fill in your name and email, and you will receive the waiver form in your email to be signed electronically. Please note that a guardian’s signature is MANDATORY if you are 17 or younger.

https://www.rabbitsign.com/template/link/tayEhwaVa6kFUCwE2NhM31


A copy of your responses will be emailed to the address you provided.
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